Heartburn differential diagnosis: Difference between revisions
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==Differentiating Heartburn from other Diseases== | ==Differentiating Heartburn from other Diseases== | ||
[[Heartburn]] must be differentiated from other causes of [[chest pain]]. Cardiac causes must be excluded since they can be life-threatening and may present with similar symptoms. In order to facilitate this, there's a table below which describes the life-threatening causes which must be differentiated: | |||
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{| class="wikitable" | {| class="wikitable" | ||
|+Differentiating [[heartburn]] from [[angina]] <ref name="urlHeartburn vs. heart attack - Harvard Health">{{cite web |url=https://www.health.harvard.edu/heart-health/heartburn-vs-heart-attack/heart-health/heartburn-vs-heart-attack/heart-health/heartburn-vs-heart-attack |title=Heartburn vs. heart attack - Harvard Health |format= |work= |accessdate=}}</ref> <ref name="pmid20003376">{{cite journal| author=Bösner S, Haasenritter J, Becker A, Hani MA, Keller H, Sönnichsen AC | display-authors=etal| title=Heartburn or angina? Differentiating gastrointestinal disease in primary care patients presenting with chest pain: a cross sectional diagnostic study. | journal=Int Arch Med | year= 2009 | volume= 2 | issue= | pages= 40 | pmid=20003376 | doi=10.1186/1755-7682-2-40 | pmc=2799444 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20003376 }} </ref> | |+Differentiating [[heartburn]] from [[angina]] <ref name="urlHeartburn vs. heart attack - Harvard Health">{{cite web |url=https://www.health.harvard.edu/heart-health/heartburn-vs-heart-attack/heart-health/heartburn-vs-heart-attack/heart-health/heartburn-vs-heart-attack |title=Heartburn vs. heart attack - Harvard Health |format= |work= |accessdate=}}</ref> <ref name="pmid20003376">{{cite journal| author=Bösner S, Haasenritter J, Becker A, Hani MA, Keller H, Sönnichsen AC | display-authors=etal| title=Heartburn or angina? Differentiating gastrointestinal disease in primary care patients presenting with chest pain: a cross sectional diagnostic study. | journal=Int Arch Med | year= 2009 | volume= 2 | issue= | pages= 40 | pmid=20003376 | doi=10.1186/1755-7682-2-40 | pmc=2799444 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20003376 }} </ref> | ||
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|[[Symptoms]] appears with physical exertion or extreme [[stress]] | |[[Symptoms]] appears with physical exertion or extreme [[stress]] | ||
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While evaluating heartburn and considering [[gastroesophageal reflux disease]] ([[GERD]]) its most probable diagnosis, there's a diagnostic approach that must be performed in order to exclude other causes, especially in high risk patients: | |||
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{{familytree/start |summary=PE diagnosis Algorithm.}} {{familytree | | | | A01 |~| A02 | A01='''Classic symptoms of GERD''' <br>(heartburn and regurgitation)|A02= If there are '''warning [[signs]]*''':<br> upper [[endoscopy]] during the initial evaluation}} | {{familytree/start |summary=PE diagnosis Algorithm.}} {{familytree | | | | A01 |~| A02 | A01='''Classic symptoms of GERD''' <br>(heartburn and regurgitation)|A02= If there are '''warning [[signs]]*''':<br> upper [[endoscopy]] during the initial evaluation}} | ||
{{familytree | | | | |!| | | | }} | {{familytree | | | | |!| | | | }} | ||
Revision as of 17:19, 1 September 2020
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Heartburn Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Heartburn differential diagnosis On the Web |
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American Roentgen Ray Society Images of Heartburn differential diagnosis |
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Risk calculators and risk factors for Heartburn differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]
Differentiating Heartburn from other Diseases
Heartburn must be differentiated from other causes of chest pain. Cardiac causes must be excluded since they can be life-threatening and may present with similar symptoms. In order to facilitate this, there's a table below which describes the life-threatening causes which must be differentiated:
| Heartburn (GERD) | Angina or Heart Attack |
|---|---|
| Burning chest pain, begins at the breastbone | Tightness, pressure, squeezing, stabbing or dull pain, most often in the center |
| Pain that radiates towards the throat | Pain radiates to the shoulders, neck or arms |
| Sensation of food coming back to the mouth | Irregular or rapid heartbeat |
| Acid taste in the back of the throat | Cold sweat or clammy skin |
| Pain worsens when patient lie down or bend over | Lightheadedness, weakness, dizziness, nausea, indigestion or vomiting |
| Appears after large or spicy meal | Shortness of breath |
| Symptoms appears with physical exertion or extreme stress |
While evaluating heartburn and considering gastroesophageal reflux disease (GERD) its most probable diagnosis, there's a diagnostic approach that must be performed in order to exclude other causes, especially in high risk patients:
| Classic symptoms of GERD (heartburn and regurgitation) | If there are warning signs*: upper endoscopy during the initial evaluation | ||||||||||||||||||
| PPI 8-week trial | |||||||||||||||||||
| If better: GERD probable | If refractory, proceed to refractory GERD algorithm | ||||||||||||||||||
* Dysphagia, bleeding, anemia, weight loss and recurrent vomiting are considered warning signs and should be investigated with upper endoscopy.
| Treat GERD: Start a 8-week course of PPI | If there are warning signs*: upper endoscopy during the initial evaluation | ||||||||||||||||||||||||||||||||||||
| Refractory GERD | |||||||||||||||||||||||||||||||||||||
| Optimize PPI therapy | |||||||||||||||||||||||||||||||||||||
| No response: Exclude other etiologies | |||||||||||||||||||||||||||||||||||||
| Typical symptoms: Upper endoscopy | Atypical symptoms: Referral to ENT, pulmonary, allergy specialist | ||||||||||||||||||||||||||||||||||||
| Abnormal: (eosinophilic esophagitis, erosive esophagitis, other) Specific treatment | NORMAL | Abnormal: (ENT, pulmonary, or allergic disorder) Specific treatment | |||||||||||||||||||||||||||||||||||
| REFLUX MONITORING | |||||||||||||||||||||||||||||||||||||
| Low pre test probability of GERD | High pre test probability of GERD | ||||||||||||||||||||||||||||||||||||
| Test off medication with pH or impedance-pH | Test on medication with impedance-pH | ||||||||||||||||||||||||||||||||||||
- High Risk: Men >50 years with chronic gastroesophageal reflux disease symptoms (>5 years), AND:
- Nocturnal reflux symptoms
- Hiatal hernia
- Elevated body mass index
- Tobacco use
- Intra-abdominal distribution of fat
- Angina / ischemia
- Ascites
- Asthma
- Barrett's esophagus
- Cardiotomy
- Caustic agent ingestion with resultant mucosal injury
- Chagas disease
- Cholelithiasis
- Clothes (elevated internal stomach pressure)
- Constipation
- Coronary artery disease
- Coughing
- CREST syndrome (Calcinosis Raynaud's phenomenon Esophagus Sclerodactyly Telangiectasias)
- Direct irritation of esophagus:
- Aspirin
- Cigarette smoke
- Citrus fruits, juice
- Ibuprofen
- Spicy foods
- Tomatoes
- Tomato sauce
- Diabetes
- Drugs:
- Esophageal atresia or fistula
- Esophageal carcinoma
- Esophageal diverticulum
- Esophageal varices
- Foods:
- Alcohol
- Chocolate
- Coffee
- Fatty foods
- Peppermint
- Soft drinks with caffeine
- Tea
- Fundectomy (postoperative)
- Gastrectomy (postoperative)
- Gastritis
- Gastroesophageal reflux disease (GERD)
- Hiatal hernia
- Infectious esophagitis
- Lifting
- Mallory-Weiss tear
- Motility disorders
- Muscle strain
- Myasthenia gravis
- Myocardial infarction
- Obesity
- Peptic ulcer disease
- Pericardial disease
- Pregnancy
- Primary reflux esophagitis
- Pulmonary embolism
- Raynaud's phenomenon
- Scleroderma
- Strictures, webs or rings
- Vagotomy (postoperative)
References
- ↑ "Heartburn vs. heart attack - Harvard Health".
- ↑ Bösner S, Haasenritter J, Becker A, Hani MA, Keller H, Sönnichsen AC; et al. (2009). "Heartburn or angina? Differentiating gastrointestinal disease in primary care patients presenting with chest pain: a cross sectional diagnostic study". Int Arch Med. 2: 40. doi:10.1186/1755-7682-2-40. PMC 2799444. PMID 20003376.